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Neurology
Research
A reliability study of colour-Doppler sonography for the diagnosis of chronic cerebrospinal venous insufficiency shows low inter-rater agreement
  1. Maurizio A Leone1,2,
  2. Olga Raymkulova1,
  3. Ausiliatrice Lucenti1,
  4. Alessandro Stecco3,
  5. Laura Bolamperti1,
  6. Lorenzo Coppo1,
  7. William Liboni4,
  8. Gianandrea Rivadossi4,
  9. Giuseppe Zaccala5,
  10. Maurizio Maggio6,
  11. Fabio Melis7,
  12. Claudia Giaccone7,
  13. Alessandro Carriero3,
  14. Piergiorgio Lochner8
  1. 1MS Centre, SCDU Neurology, Head and Neck Department, AOU ‘Maggiore della Carità’, Novara, Italy
  2. 2IRCAD, Interdisciplinary Research Centre of Autoimmune Diseases, Novara, Italy
  3. 3Institute of Diagnostic and Interventional Radiology, AOU ‘Maggiore della Carità’, Novara, Italy
  4. 4Fondazione ‘Un passo insieme’, Valdellatorre, Italy
  5. 5Department of Medicine, AOU ‘Maggiore della Carità’, Novara, Italy
  6. 6SC Neurology, Civile Hospital, Ivrea, Italy
  7. 7SC Neurology, Maria Vittoria Hospital, Torino, Italy
  8. 8Department of Neurology, Tappeiner Hospital, Merano, Italy
  1. Correspondence to Dr Maurizio A Leone; maurizio.leone{at}maggioreosp.novara.it

Abstract

Objective Chronic cerebrospinal venous insufficiency (CCSVI) has been extremely variable, associated with multiple sclerosis in colour-Doppler sonographic studies. We aimed to evaluate inter-rater agreement in a colour-Doppler sonography venous examination.

Design Inter-rater agreement study.

Setting First-referral multiple sclerosis centre.

Participants 38 patients with multiple sclerosis and 55 age-matched (±5 years) controls.

Intervention Sonography was carried out in accordance with Zamboni’s five criteria by eight sonographers with different expertise, blinded to the status of cases and controls. Each participant was evaluated by two operators.

Primary and secondary outcome measures Inter-rater agreement was measured through the κ statistics and the intraclass correlation coefficient.

Results The agreement was no higher than chance for criterion 2—reflux in the deep cerebral veins (κ=−0.02) and criterion 4—flow not Doppler detectable in one or both the internal jugular veins (IJVs) or vertebral veins (VVs; −0.09). It was substantially low for criterion 1—reflux in the IJVs and/or VVs (0.29), criterion 3—IJV stenosis or malformations (0.23) and criterion 5—absence of IJV diameter increase when passing from the sitting to the supine position (0.22). The κ value for CCSVI as a whole was 0.20 (95% confidence limit −0.01 to 0.42). Intraclass correlation coefficients for the measure of cross-sectional area ranged from 0.05 to 0.25. Inter-rater agreement was low for CCSVI experts (κ=0.24; −0.11 to 0.59) and non-experts (0.20; −0.33 to 0.73); neurologists (0.21; −0.06 to 0.47) and non-neurologists (0.18; −0.20 to 0.56); cases (0.19; −0.14 to 0.52) and controls (0.21; −0.08 to 0.49). Zamboni-trained neurosonographers ascertained CCSVI more frequently than the non-trained neurosonographers.

Conclusions Agreement was unsatisfactory for the diagnosis of CCSVI as a whole, for each of its five criteria and according to the different subgroups. Standardisation of the method is urgently needed prior to its further application in studies of patients with multiple sclerosis or other neurological diseases.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/bmjopen-2013-003508

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